Collecting Branch : EPS1 Servicing Branch : LIC of India, Palwal Branch

1st Floor Above P N Bank.

Transaction No : 2789758
Railway Road Palwal ,Haryana
Date ( Time ): 07/05/2019 ( 18:32:10 ) Palwal,0
bo_eps1@licindia.com
Receipt No : PR0278975800011920
HelpDesk: +91-022-1251

RENEWAL PREMIUM RECEIPT

Received with thanks ` 1,516.00 through Payment Gateway over the Internet from:

Smt./Ms./Shri : Susheel Kumar

towards the following :

Policy No Plan Inst. Premium No Of Inst Total Premium CGST Branch

Name Term Mode Due From Late Fee SGST/UTGST Next Due
Agency Code D.O.C. Sum Assured Due To CD Charges Total Amt Reg. No.
(`) (`) (`)
126242572 165 1,516.00 1 1,516.00 0.00 11H
Susheel Kumar 22 HLY 05/19 0.00 0.00 11/19
0251811H 28/11/2011 62,500.00 05/19 0.00 1,516.00

Page Total (`) 1,516.00 1,516.00 0.00

0.00 0.00
0.00 1,516.00
Grand Total (`) 1,516.00 1,516.00 0.00
0.00 0.00
0.00 1,516.00

GST borne by LIC of India ` 34.12

ONE THOUSAND FIVE HUNDRED SIXTEEN RUPEES AND ZERO PAISE ONLY

Susheel Kumar
S/O Sh Devi Ram
H.No.454,Sec-2,Housing Board Colony
Palwal

121102 Payment Acknowledgement generated through

Online Portal on 07-May-19 Time : 18:34:24.
Mobile: 8700899845
Email: susheelkumar136@gmail.com

This receipt is electronically generated and no signature is required.

Har Pal Aapke Saath!